Examining the Risks of Cardiac Arrhythmia and Mortality among New-Generation Macrolides, Fluoroquinolones, and Beta-Lactam/Beta-Lactamase Inhibitor: A Nationwide Study.
Clin Infect Dis. 2014 Nov 18;
Authors: Chou HW, Wang JL, Chang CH, Lai CL, Lai MS, Chan KA
BACKGROUND: Previous studies have demonstrated increased cardiovascular mortality related to azithromycin and levofloxacin. Risks associated with alternative drugs in the same class, including clarithromycin and moxifloxacin, were unknown. We used the Taiwan National Health Insurance Database to perform a nationwide, population-based study that compares the risks of ventricular arrhythmia and cardiovascular death among these antibiotics.
METHOD: A total of 10,684,100 patients prescribed oral azithromycin, clarithromycin, moxifloxacin, levofloxacin, ciprofloxacin, or amoxicillin/clavulanate at outpatient visit between January 2001 and November 2011. A logistic regression model adjusted for propensity score was used to calculate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for adverse cardiac outcomes occurring within 7 days after the initiation of antibiotic treatment.
RESULT: Compared with amoxicillin-clavulanate treatment, the use of azithromycin and moxifloxacin were associated with significant increases in the risks of ventricular arrhythmia and cardiovascular death. The adjusted ORs (95% CI) for ventricular arrhythmia were 4.32 (2.95-6.33) for azithromycin, 3.30 (2.07-5.25) for moxifloxacin, and 1.41 (0.91-2.18) for levofloxacin. For cardiovascular death, the adjusted ORs (95% CI) for azithromycin, moxifloxacin, and levofloxacin were 2.62 (1.69-4.06), 2.31 (1.39-3.84), and 1.77 (1.22-2.59), respectively. No association was noted between clarithromycin or ciprofloxacin and adverse cardiac outcomes.
CONCLUSION: Healthcare professionals should consider the small but significant increased risk of ventricular arrhythmia and cardiovascular death when prescribing azithromycin and moxifloxacin. Additional research is needed to determine whether the increased risk of mortality is caused by the drugs, or related to the severity of infection or the pathogens themselves.
PMID: 25409476 [PubMed - as supplied by publisher]